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A collaboration between nursing home staff and hospital clinicians reduced readmission and mortality rates and improved quality of life for residents with hip fracture, a new study from Denmark finds.

Investigators followed healthcare outcomes among 100 patients who were treated for hip fracture and discharged to nursing home facilities for post-acute care from January 2018 to July 2020. The patients’ median age was 86, and 60% had cognitive decline.

Participating nursing homes collaborated with acute-care staff to provide a three-part, 14-day collaborative intervention in addition to usual care. 

In Denmark, the average length of hospital stay for hip fractures is approximately one week, and the hospital is not involved in post-surgical treatment. The study’s authors sought to find out how direct cooperation between healthcare settings impacted the outcomes of frail patients in post-acute care.

A three-part intervention

The intervention consisted of standardized interdisciplinary cooperation between the hospital, nursing home staff and visiting acute team nurses.

Patients received a tailored discharge treatment plan from the hospital including wound care and mobilization therapy. The intervention also included a safety program, with regular assessment of vital signs, weight, pain, signs of constipation, hours of mobilization, and daily intake of fluids and high-protein beverages. 

In addition, specialized acute-care nurses regularly visited the nursing facilities to take blood samples and administer intravenous fluids or antibiotics. The nurses were also allowed to assess the patient’s progress and were given the option of calling acute-care orthopedic geriatricians for help, or to request additional assessments as needed.

In cases where blood sample levels were concerning or there was evidence of clinical deterioration, a new treatment plan was requested from the hospital team. A control group of 150 patients received usual care in another set of participating nursing homes. 

Collaboration pays off

There was a significant difference in 30-day readmission rates between the cohorts, at 14% in the intervention group compared with 30% in the control group, the authors reported. Deaths within 30 days of nursing home admission were also lower in the intervention cohort, at 6%, when compared to 13% in the control group. The intervention group also had higher health-related quality of life scores. There was no difference in mobility measures.

The researchers attributed the relatively improved outcomes to the interdisciplinary collaboration — and to the intervention’s skirting of the usual siloed care.

Bypassing the usual care path

Stakeholders must improve their ability to recognize frail patients at risk of poor outcomes and be willing to bypass the limitations of the usual healthcare pathways to provide optimal care, wrote Bjarke Viberg, M.D., Ph.D., of the University of Southern Denmark, and colleagues.

In the case of vulnerable, elderly hip fracture patients, this can be done by ensuring that simple post-discharge measurements are created, and that nursing home staff have easy access to the specialized hospital team, they said.

It is “important to critically assess the traditional health care pathways and instead assess systems with interventions that would improve appropriate health care utilization,” they concluded.

Full findings were published in JAMDA.

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